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Oral Candidiasis (Thrush)

November 2005


Topical treatment (active only on the area where applied) is generally the first choice for oral candidiasis and usually works for mild-to-moderate cases. Topical treatments for oral candidiasis include lozenges (also called trouches) and mouth rinses.

One or two lozenges are taken for oral symptoms three to five times a day. They should be sucked slowly and not chewed or swallowed whole. Common brands are clotrimazole (Mycelex) and nystatin (Mycostatin).

Mouth rinses are generally less effective than lozenges since they are only in contact with the mouth for a short time. However, they may be the best choice for someone who has a very sore and dry mouth. Rinses are taken in between meals, in a measured amount and are held in the mouth for as long as possible. They should be swilled around in the mouth, then swallowed. They are used at least four times a day and should be continued for a few days after the symptoms have gone (generally two weeks). The most widely used rinse is nystatin (Mycostatin).

Systemic treatment (treatments that work throughout the body) are used for recurring candidiasis or outbreaks that do not clear up with topical treatment. They are also used for esophageal candidiasis.

Three anti-fungal drugs are approved for use in treating oral and esophageal candidiasis. They include ketoconazole (Nizoral), fluconazole (Diflucan) and itraconazole (Sporanox). Generally, doctors will start out with less aggressive therapies (like ketaconazole or itraconazole) and save the more potent fluconazole for later use, if necessary. If candidiasis does not improve with these drugs (i.e. becomes "azole" resistant), another drug, called amphotericin B (Fungizone) is often tried.

The dose of fluconazole is 200mg once a day for oral and esophageal candidiasis. Treatment typically lasts two weeks for oral candidiasis and three weeks for esophageal infection (or two weeks after symptoms clear up, whichever is longer).

Itraconazole is usually taken at a dose of 100mg once a day for oral candidiasis for one-to-two weeks and 200mg once a day for esophageal candidiasis for two to three weeks. It should also be taken with food. Itraconazole oral solution gives higher levels of the drug in the blood than the capsule and has been shown to be more effective. There is a greater potential for interactions between itraconazole and many anti-HIV therapies. For more information on drug interactions, call Project Inform's Infoline and ask for Drug Interactions.

Ketoconazole (Nizoral) is usually taken at a dose of 200mg once a day for oral candidiasis for one-to-two weeks and 400mg once a day for esophageal candidiasis for two-to-three weeks. It should be taken with food. It may not be well absorbed in people with gut problems or who cannot eat very much. Taking it with an acidic drink (such as cola) may help.

Amphotericin B (Fungizone) is administered by an oral solution (100mg a day four times daily) or through intravenous injection (generally .5mg/kg a day) for two to three weeks. Newer liposomal versions of the drug, such as amphotericin B lipid complex (Abelcet), is administered by intravenous injection at a rate of 5mg/kg a day for two to three weeks.

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